How to be a “Good” 3rd Year Medical Student: Get Comfortable

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By Luke Murray

How to be a Good 3rd Year Medical Student - Get ComfortableIn my last few posts I’ve argued that all you have to do to be a “good” third year medical student is be “engaged.” In order to make this insight more actionable, I described the biggest source of disengagement for me (not accepting my circumstances and calibrating my expectations) and what I wish I had done about it. In the third article, I talked about distractions as a source of disengagement, and what I did to minimize my own. In this final post, I’ll talk about the last category of reasons for which I found myself mentally unplugged during rounds: physical discomfort.

There’s no denying that being “engaged” is mentally and physically taxing. And the more physical discomforts you have to ignore in order to keep your head in the game, the more exhausting it is – and the less likely you’ll be able to keep it up. This experience is called ego depletion, which is “the concept that self-control or willpower draw upon a limited pool of mental resources that can be used up. When the energy for mental activity is low, self-control is typically impaired, which would be considered a state of ego depletion.” The following were my biggest “ego depleters” and what I did (or should have done) about them. (more…)

USMLE-Rx Step 1 Qmax Challenge #3406

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 1 Qmax Challenge #3406A 48-year-old woman presents to her physician with a 2-month history of dull left upper quadrant pain and chronic fatigue. Laboratory evaluation reveals the patient is anemic, and further tests indicate she has a malignancy. Her peripheral blood smear is shown in the image. The patient’s condition is highly susceptible to a single drug treatment regimen that results in the inhibition of a critical oncogene.

The drug in question interacts most strongly with which of the following signaling pathways?

A. G protein-coupled receptor signaling
B. NF-?B signaling pathway.
C. Steroid receptor signaling
D. TGF-? receptor signaling pathway
E. Tyrosine receptor kinase signaling

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Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 1 test bank. For more USMLE Step 1 prep, subscribe to our Flash Facts and Step 1 Express video series. Score the best deal on all three products with a Step 1 Triple Play Bundle.

Napkin Drawing #2: D-dimer, FDP, and Rabbit Holes

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By Mark Ard

Napkin Drawing 2 D-dimer, FDP, and Rabbit HolesI vividly remember this topic from Kaplan Q bank, UWorld, and my Step 1 test. It always boiled down to the same question, what’s the difference between elevated d-dimer and elevated fibrin degradation products (FDP). (If Step 1 questions were written like that, life would be so much easier).

Of course, a good Step 1 question will assume you know the basics and wants a deeper understanding. Did this patient recently have a radical prostatectomy and release a large amount of urokinase? Do you think his nosebleed is from picking it too aggressively, or is it the first sign of DIC, followed by bleeding out of every orifice and IV site? Does the fact that his liver enzymes are sky high explain the high FDP and low d-dimer (the answer is yes, the liver makes anti-plasmin). (more…)

USMLE-Rx Step 2 Qmax Challenge #21169

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Check out today’s Step 2 CK Qmax Question Challenge.

Know the answer? Post it in the comments below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21169Five full-term infants are enrolled in a study in which their total bilirubin level is measured daily for the first week of life and then weekly for the next 21 days. The chart lists total serum bilirubin (in milligrams per deciliter) for each infant for the duration of the study.

Which of the following infants has physiologic jaundice?

A. Infant A
B. Infant B
C. Infant C
D. Infant D
E. Infant E

———————–

Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 2 CK test bank. Get more Step 2 CK study help at USMLE-Rx.com.

Study Timing: How Soon Is Too Soon?

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By Tim Durso

Study Timing - How Soon Is Too SoonThere’s one age old question that inevitably creeps into the forefront of the (admittedly neurotic) mind of many medical students during the pre-clinical years:

“When should I start studying for Step 1?”

For a question that seems so universal, the answer is far from it. I’ll give you my perspective on the issue, and granted it it’s a sample size of one (great time to review study power in your handy-dandy copy of First Aid), but it’s a strategy that put me in a position to exceed even my own expectations on test day. (more…)

USMLE-Rx Step 1 Qmax Challenge #3403

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Check out today’s Step 1 Qmax Question Challenge.

Know the answer? Post it below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 1 Qmax Challenge #3403A 63-year-old woman presents to the emergency department complaining of a productive cough with green sputum. She smoked 1.5 packs of cigarettes per day for the past 30 years and had several hospitalizations in the past 15 years for lung infections. She reports some friends in her nursing home have been sick recently with “some sort of lung infection.” Further work-up is indicated and CT of the chest is ordered (see image).

What pathology is most likely present in this patient?

A. Bronchiectasis
B. Lung cancer
C. Pneumonia
D. Pulmonary embolism
E. Tuberculosis

———————–

Want to know the ‘bottom line?’ Purchase a USMLE-Rx Subscription and get many more features, more questions, and passages from First Aid, including images, references, and other facts relevant to this question.

This practice question is an actual question from the USMLE-Rx Step 1 test bank. For more USMLE Step 1 prep, subscribe to our Flash Facts and Step 1 Express video series. Score the best deal on all three products with a Step 1 Triple Play Bundle.

Mnemonic Monday: Argyll-Robinson Pupil

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By Haley Masterson

To remember the ocular symptoms of Argyll-Robinson Pupil, just take the first letter of each word – ARP – and read it forwards and backwards. Forwards, you have ARP – Accommodation Reflex Present. Backwards, you have PRA – Pupillary Reflex Absent.

Usually the constriction to light is stronger than constriction to a near stimulus, but the reverse is true in the case of Argyll-Robinson pupil. Remember that “accommodation” refers to the ability of the eyes to focus on a near object. This reflex is carried out in part by pupillary constriction – so the pupils will constrict as you bring a far object into the near eye field – for example, moving your finger close to the patient’s nose. However, the “pupillary reflex” refers to the ability of the eye to constrict when exposed to a bright stimulus, such as your pen light. (more…)

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